Lazy eye treatment, patching, supplements, medications
Feb 22 2014 by
Ray Sahelian, M.D. natural health center

Amblyopia  or “lazy eye” is weak vision or vision loss in one eye that cannot be fully corrected with lenses. This is an eye disorder that usually develops in children before age eight. This is also the key time to treat this condition, since results are better the earlier they are implemented. It becomes extremely difficult to treat lazy eye after age eight to ten. Untreated, it can, in rare cases, lead to severe loss of vision in the affected eye.

Patching the eye
All grades of part-time occlusion are comparable to full-time occlusion in effectiveness of treatment for mild to moderate amblyopia in children between 7-12 years of age unlike in severe amblyopia, where six hours and full-time occlusion were more effective than two hours occlusion therapy. Indian J Ophthalmol. 2008. Part-time occlusion therapy for amblyopia in older children. Singh I, Sachdev N, Brar GS, Kaushik S.Grewal Eye Institute, Chandigarh, India.

Am Orthopt J. 2013. Part-time vs. full-time occlusion for amblyopia: evidence for part-time patching. Occlusion therapy has been used for years to improve acuity, and, traditionally, practitioners have utilized full-time patching.

Lazy eye treatment in older children
Some children aged seven to 17 who had previously been thought too old to benefit from lazy eye treatment showed improvement in a clinical trial. Although it is widely agreed that lazy eye, a condition that involves poor vision and/or poor muscle control of one eye, can be effectively treated in children younger than six, it has generally been believed that older children were unlikely to benefit from treatment. The upper limit for successful treatment response has been believed to be seven to ten years of age. The study was designed to evaluate the effectiveness of treatment of lazy eye in children aged seven to 17 years. Mitchell M. Scheiman, O.D., Richard W. Hertle, M.D., and colleagues in the Pediatric Eye Disease Investigator Group conducted a randomized treatment trial of 507 older children with lazy eyes. All the patients were provided with optimal optical correction (children who already had glasses were given new ones). Children were then randomly assigned to receive treatment or to receive optical correction alone. Children aged seven to 12 in the treatment group were treated with two to six hours a day of patching over the sound eye combined with near visual activities such as playing with a GameBoy, homework, or reading, and one drop daily of atropine for the sound eye. Patients in the older treatment group (aged 13 to 17 years) were treated with patching and near visual activities alone. Follow up visits occurred every six weeks for up to 24 weeks until the patients were classified as a responder or non-responder. A patient in the study was classified as a responder if the amblyopic eye acuity (sharpness of vision) was 10 or more letters (two lines on the eye chart) better than baseline. A patient was classified as a non-responder if amblyopic eye acuity had not improved 10 or more letters by the 24th week or if there was no improvement at all from a prior follow-up visit (or baseline). Of the 404 seven- to 12-year-olds in the study, 53 percent (106 of 201) in the lazy eye treatment group were responders compared with 25 percent in the optical correction group. Of the 13- to 17- year-olds, 25 percent of the treatment group (14 of 55) were responders compared with 23 percent of the optical correction group (11 of 48). However, of the13- to 17- year-olds who had not previously been treated for lazy eye, 47 percent (eight of 17) responded to treatment compared to 20 percent (four of 20) who did not. 2005 issue of Archives of Ophthalmology.

Acupuncture
A very skilled acupuncturist could provide benefits. Arch Ophthalmol. 2010. Randomized Controlled Trial of Patching vs Acupuncture for Anisometropic Amblyopia in Children Aged 7 to 12 Years. Joint Shantou International Eye Center of Shantou University and the Chinese University of Hong Kong, Shantou, China, North Dongxia Road, Shantou, Guangdong, China.

Medication
Levodopa/carbidopa in the treatment of amblyopia. Dadeya S, Vats P, Malik KP. Guru Nanak Eye Center, Maulana Azad Medical College, Delhi, India.
J Pediatr Ophthalmol Strabismus. 2009. To evaluate the role of levodopa/carbidopa in the treatment of amblyopia.
Thirty patients with strabismic amblyopia between the ages of 3 and 12 years were part of this double-blind, randomized study. Patients were divided into two groups. Group A received 0.50 mg + 1.25 mg of levodopa / carbidopa per kilogram body weight three times daily after meals, with a protein rich drink, whereas Group B received placebo. Both groups received full-time conventional occlusion until a visual acuity of 6/6 was achieved or for a maximum of 3 months. The authors observed more than two lines improvement in visual acuity that was greater in the levodopa group (15 of 15) than in the placebo group (9 of 15). Furthermore, improvement in visual acuity of more than two lines was greater in patients younger than 8 years (100%) than in patients older than 8 years of age (60%). There was also no significant reversal of the improved visual acuity in up to 6 months of follow-up.  Levodopa / carbidopa improves visual acuity in patients with amblyopia and maintains improved visual acuity, especially in patients younger than 8 years.

Natural supplements
See this eyesight page for natural herbs, vitamins, dietary supplements that can improve visual acuity.

Eyesight Rx for Better Vision
Supplement Facts:
Vitamin C (Ascorbic acid)
Citrus bioflavonoids
     (eriocitrin, hesperidin, flavonols, flavones, flavonoids, naringenin, and quercetin)
Mixed carotenoids
     (astaxanthin, beta carotene, cryptoxanthin, lutein,
Lycopene, Zeaxanthin)
Bilberry extract (Vaccinium myrtillus)
Jujube extract (Zizyphus jujube)
Ginkgo biloba (Ginkgo biloba)
Suma extract (Pfaffia paniculata)
Mucuna pruriens extract (Cowhage)
Cinnamon (Cinnamomum zeylanicum)
Lycium berry extract (Lycium Barbarum)
Sarsaparila (Sarsaparilla Smilax)
Alpha lipoic acid antioxidant

Lazy eye research
Lazy eye characterization, treatment, and prophylaxis.
Surv Ophthalmol. 2005. Pediatric Vision Laboratory, Krieger Children's Eye Center, Wilmer Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
Lazy eye has a 1.6-3.6% prevalence, higher in the medically underserved. It is more complex than simply visual acuity loss and the better eye has sub-clinical deficits. Functional limitations appear more extensive and loss of vision in the better eye of amblyopes more prevalent than previously thought. lazy eye screening and treatment are efficacious, but cost-effectiveness concerns remain. Refractive correction alone may successfully treat anisometropic lazy eye and it, minimal occlusion, and/or catecholamine treatment can provide initial vision improvement that may improve compliance with subsequent long-duration treatment. Atropine penalization appears as effective as occlusion for moderate lazy eye, with limited-day penalization as effective as full-time. Cytidin-5'-diphosphocholine may hold promise as a medical treatment. Interpretation of much of the lazy eye literature is made difficult by: inaccurate visual acuity measurement at initial visit, lack of adequate refractive correction prior to and during treatment, and lack of long-term follow-up results. Successful treatment can be achieved in at most 63-83% of patients. Treatment outcome is a function of initial visual acuity and type of lazy eye, and a reciprocal product of treatment efficacy, duration, and compliance. Age at treatment onset is not predictive of outcome in many studies but detection under versus over 2-3 years of age may be. Multiple screenings prior to that age, and prompt treatment, reduce prevalence. Would a single early cycloplegic photoscreening be as, or more, successful at detection or prediction than the multiple screenings, and more cost-effective? Penalization and occlusion have minimal incidence of reverse lazy eye and/or side-effects, no significant influence on emmetropization, and no consistent effect on sign or size of post-treatment changes in strabismic deviation. There may be a physiologic basis for better age-indifferent outcome than tapped by current treatment methodologies. Infant refractive correction substantially reduces accommodative esotropia and lazy eye incidence without interference with emmetropization. Compensatory prism, alone or post-operatively, and/or minus lens treatment, and/or wide-field fusional amplitude training, may reduce risk of early onset esotropia. Multivariate screening using continuous-scale measurements may be more effective than traditional single-test dichotomous pass/fail measures. Pigmentation may be one parameter because Caucasians are at higher risk for esotropia than non-whites.

Questions
Is lazy eye surgery effective?
   Done by an experienced opthalmologist, lazy eye surgery can lead to correction of the eye disorder in many people and is considered an effective method.

I have a lazy eye since 20 years. i am a medical professional and looking for treatment. Some occlusion, vision therapy, etc...but no hope...do you have any news about naturopathic treatments.